Chronic fatigue syndrome (CFS) is disabling fatigue lasting more than six months that reduces activity by more than half. CFS is a poorly understood disease involving many body systems. No single cause of CFS has been identified, therefore, it is diagnosed by symptoms and by ruling out other known causes of fatigue by a healthcare practitioner.

Suggested causes include chronic viral infections, food allergy, adrenal gland dysfunction, and many others. None of these have been convincingly documented in more than a minority of sufferers. In some people there is also difficulty sleeping, swollen lymph nodes, and/or mild fever. When there is muscle soreness, fibromyalgia may be the actual problem. Although CFS is considered a modern diagnosis, it may have existed for centuries under other names, such as “the vapors,” neurasthenia, “effort syndrome” (diagnosed in World War I veterans), hypoglycemia, and chronic mononucleosis.

For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms of chronic fatigue syndrome?In addition to fatigue, there may also be muscle pain, joint pain not associated with redness or swelling, short-term memory loss, and an inability to concentrate. Some people with chronic fatigue syndrome also experience difficulty sleeping, swollen lymph nodes, and/or mild fever.

Dietary changes that may be helpful for chronic fatigue syndrome

Some doctors believe that people with CFS who have low blood pressure should not restrict their salt intake. Among CFS sufferers who have a form of low blood pressure triggered by changes in position (orthostatic hypotension), some have been reported in a preliminary study to be helped by additional salt intake.1 People with CFS considering increasing salt intake should consult a doctor before making such a change. (See the Herb information, below, for more information on blood pressure and CFS.)

Lifestyle changes that may be helpful for chronic fatigue syndrome

Exercise is important to prevent the worsening of fatigue. Many people report feeling better after undertaking a moderate exercise plan.2 3 However, most people with CFS are sensitive to overexertion, and excessive exercise may lead to consistently worsening fatigue and mental functioning.4 5 6 Exercise should be attempted gradually, starting with very small efforts. One small study found that intermittent exercise, in which patients walked for three minutes followed by three minutes of rest for a total of 30 minutes, did not exacerbate their CFS symptoms.7

Nutritional supplements that may be helpful for chronic fatigue syndrome

The combination of potassium aspartate and magnesium aspartate has shown benefits for chronically fatigued people in double-blind trials.8 9 10 11 However, these trials were performed before the criteria for diagnosing CFS was established, so whether these people were suffering from CFS is unclear. Usually 1 gram of aspartates is taken twice per day, and results have been reported within one to two weeks.

Vitamin B12 deficiency may cause fatigue. However, some reports,12 even double-blind ones,13 have shown that people who are not deficient in B12 have increased energy following a series of vitamin B12 injections. Some sources in conventional medicine have discouraged such people from taking B12 shots despite this evidence.14 Nonetheless, some doctors have continued to take the limited scientific support for B12 seriously.15 In one preliminary trial, 2,500 to 5,000 mcg of vitamin B12 given by injection every two to three days led to improvement in 50 to 80% of a group of people with CFS; most improvement appeared after several weeks of B12 shots.16 While the research in this area remains preliminary, people with CFS considering a trial of vitamin B12 injections should consult a doctor. Oral or sublingual B12 supplements are unlikely to obtain the same results as injectable B12, because the body’s ability to absorb large amounts is relatively poor.

A preliminary trial has shown that people with CFS have reduced functional B-vitamin status when compared to people without the condition.17 The functional vitamin deficiency seen in this study was most pronounced for vitamin B6. Double-blind trials are needed to establish whether B-vitamin supplementation is effective in people with chronic fatigue syndrome.

L-carnitine is required for energy production in the powerhouses of cells (the mitochondria). There may be a problem in the mitochondria in people with CFS. Deficiency of carnitine has been seen in some CFS sufferers.18 One gram of carnitine taken three times daily for eight weeks led to improvement in CFS symptoms in one preliminary trial.19

NADH (nicotinamide adenine dinucleotide) helps make ATP, the energy source the body runs on. In a double-blind trial, people with CFS received 10 mg of NADH or a placebo each day for four weeks.20 Of those receiving NADH, 31% reported improvements in fatigue, decreases in other symptoms, and improved overall quality of life, compared with only 8% of those in the placebo group. Further double-blind research is needed to confirm these findings.

Magnesium levels have been reported to be low in CFS sufferers. In a double-blind trial, injections with magnesium improved symptoms for most people.21 Oral magnesium supplementation has improved symptoms in those people with CFS who previously had low magnesium levels, according to a preliminary report, although magnesium injections were sometimes necessary.22 These researchers report that magnesium deficiency appears to be very common in people with CFS. Nonetheless, several other researchers report no evidence of magnesium deficiency in people with CFS.23 24 25 The reason for this discrepancy remains unclear. If people with CFS do consider magnesium supplementation, they should have their magnesium status checked by a doctor before undertaking supplementation. It appears that only people with magnesium deficiency benefit from this therapy.

Dehydroepiandrosterone, more commonly known as DHEA, is a hormone now available as a supplement. In one report, DHEA levels were found to be low in people with CFS.26 Another research group reported that, while DHEA levels were normal in a group of CFS patients, the ability of these people to increase their DHEA level in response to hormonal stimulation was impaired.27 Whether supplementation with DHEA might help CFS patients remains unknown due to the lack of controlled research. DHEA should not be used without the supervision of a healthcare professional.

Are there any side effects or interactions with chronic fatigue syndrome?

Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful for chronic fatigue syndrome

Some research suggests that CFS may be partially due to low adrenal function resulting from different stressors (e.g., mental stress, physical stress, and even viral illness) and impacting the normal communication between the hypothalamus, pituitary gland, and the adrenal glands.28 Licorice root is known to stimulate the adrenal glands and to block the breakdown of active cortisol in the body.29 One case report described a man with CFS whose symptoms improved after taking 2.5 grams of licorice root daily.30 While there have been no controlled trials to test licorice in patients with CFS, it may be worth a trial of six to eight weeks using 2 to 3 grams of licorice root daily.

Adaptogenic herbs such as Asian ginseng and eleuthero may also be useful for CFS patients—the herbs not only have an immunomodulating effect but also help support the normal function of the hypothalamic-pituitary-adrenal axis, the hormonal stress system of the body.31 These herbs are useful follow-ups to the six to eight weeks of taking licorice root and may be used for long-term support of adrenal function in people with CFS. However, no controlled research has investigated the effect of adaptogenic herbs on CFS.

Are there any side effects or interactions with chronic fatigue syndrome?

Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful for chronic fatigue syndrome

Highly stressful situations should be avoided by people with CFS. Coping mechanisms for dealing with stress can sometimes be maximized by behavioral therapy, which has been shown helpful for people with CFS in several controlled studies.32